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General NPI Number Information
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NPI Number | 1669662284
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Entity Type | Individual
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Provider Name | JULIE ANN RIDDLE LICSW
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Gender | Female
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 10/02/2019
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Provider Practice Location Address
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Address Line | 117 N WASHINGTON ST STE 3
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City | GRAND FORKS
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State | ND
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Zip | 58203-3450
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Country | US
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Telephone | 218-791-0401
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Fax | 701-757-1500
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Provider Business Mailing Address
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Address Line | 117 N WASHINGTON ST STE 3
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City | GRAND FORKS
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State | ND
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Zip | 58203-3450
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Country | US
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Telephone | 218-791-0401
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Fax | 701-757-1500
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3618
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License Number State | ND
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